Nassau University Medical Center East Meadow, NY, United States
Atul Sinha, MD, Nausheer Khan, MD Nassau University Medical Center, East Meadow, NY
Introduction: Hiccups are involuntary diaphragmatic contractions that are typically benign. The most common gastrointestinal causes of hiccups are abdominal inflammation and distension. Another cause is malignancy, particularly gastric and esophageal. Metastatic adenocarcinoma of the colon is a rarely seen cause of persistent hiccups.
Case Description/Methods: We present a case of a 67-year-old Haitian male who presented to the emergency department after a syncopal episode. Patient had been discharged from the ED earlier in the day after presenting for 5 days of hiccups. Patient now endorsed a 20-30 lb weight loss over past 6 months due to decreased appetite. Upon further workup, patient was found to have anemia with Hg of 9.2 g/dl and iron < 15 mcg/dl. Imaging showed colonic wall thickening and innumerable liver lesions (Image 1). Colonoscopy revealed near complete obstruction by a transverse colon mass. Patient underwent colectomy with colostomy and liver biopsy; pathology revealed invasive adenocarcinoma and metastatic adenocarcinoma with extensive necrosis. Symptoms resolved after colectomy and patient began outpatient treatment with oncology.
Discussion: We choose to present this case because of the typically harmless nature of hiccups. We all experience this annoyance but are quick to dismiss it after resolution. It is important for physicians to obtain a more thorough history because such a benign sign may be the manifestation of something much more severe. In the case of colorectal cancer, we are taught to look for weight loss, melena, change in bowel habits, and fatigue. In this case our patient initially presented with hiccups, which to him was his chief complaint and the sole reason for going to the ED. Cases like this can be missed without a thorough history and review of systems. Once gastroenterological etiologies are considered a cause of hiccups, physicians are tasked to determine the location. Although the most likely gastrointestinal sources of persistent hiccups are related to the upper GI tract, physicians must consider lower GI causes as well. Colonoscopy and imaging can help physicians make a diagnosis in these cases and allow for rapid and targeted treatment.
Figure: Computerized tomography scan of abdomen showing adenocarcinoma of the colon with metastasis to the liver
Atul Sinha indicated no relevant financial relationships.
Nausheer Khan indicated no relevant financial relationships.
Atul Sinha, MD, Nausheer Khan, MD. P1287 - Metastatic Adenocarcinoma of the Colon Presenting as Persistent Hiccups, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.